Dr. Chapa’s OBGYN Clinical Pearls Use Antibiotics at 2nd Degree OB Lac Repair?
Nov 6, 2025
The podcast dives into the controversial use of prophylactic antibiotics during second-degree laceration repairs. It evaluates the latest BMJ randomized trial and a meta-analysis revealing mixed evidence on infection rates. Dr. Chapa discusses why recommendations often lag behind emerging data and contrasts protocols for more severe injuries. He also shares insights on practical applications for high-risk patients. Ultimately, a modest benefit for antibiotics is identified, but universal use remains unadvised.
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Evidence Exists But Guidelines Lag
- There is existing data suggesting antibiotics at second-degree repair can reduce wound issues but guidelines lag behind evidence.
- ACOG and other societies currently do not recommend routine antibiotics for first- or second-degree tears.
Use Antibiotics Selectively For High-Risk Patients
- Consider single-dose prophylactic antibiotics selectively for high-risk patients with second-degree tears.
- Document your rationale when giving antibiotics to avoid peer-review issues.
Meta-Analysis Shows Benefit But Calls For More RCTs
- A May 2025 systematic review found reduced perineal wound infection with prophylactic antibiotics but judged trials insufficient for guideline change.
- Authors called for adequately powered RCTs to inform practice.
